Feedback in a heartbeat

iPads with Heartbeat's app are currently in use at Charité's breast cancer centre.

A new Berlin start-up wants to know how you’re feeling. Really.

Like most startup founders, Heartbeat Medical’s Yannik Schreckenberger is extremely enthusiastic, and serious about what he does. Within minutes of meeting him at Heartbeat’s Fehrbelliner Straße offices, we’re the ones being asked the questions. “Imagine for a minute you’re looking for medical treatment,” he starts. “What do you do?”

“Erm... panic and Google,” is the best we can come up with. Apparently we’re not alone. But, as Schreckenberger explains, going online and finding somewhere with positive reviews doesn’t give you any measure of whether a particular doctor will be able to effectively treat your symptoms, or whether you’ll need to go back again. In other words, the outcome of your treatment. But what if there was a way to benchmark that, too?

Enter Heartbeat. Since 2014, the Cologne- founded, now Berlin-based start-up has been delivering its Heartbeat ONE software to clinics and medical centres across Germany to measure patient-reported outcomes of surgical procedures. Schreckenberger explains that standard metrics after surgery typically cover only clinical values such as dosages, swelling and infection. But the parameters that matter the most to patients go unreported – if you’ve had a knee operation, for example, the most important thing is whether you’re able to get back to every day activities. A patient-reported outcome is a measure of personal feedback, gathered by asking patients a series of personal, lifestyle questions before, during and after their operations, such as “How much did pain interfere with your normal work?” or “Have you felt downhearted and blue?” Most clinics give patients on-paper questionnaires at the time of surgery, but, says Schreckenberger, “Very few have the budget and resources to do long-term follow-up on what patients are able to do and how they feel over a series of years. Our software automates this.”

The app’s findings can be published externally to reassure patients, but for the most part, they’re being used by doctors and senior management to assess patients, improve practices and save time. Like many healthcare trends, the concept is an import from Stateside. Around the world (and Germany is no exception), health care systems are struggling with rising costs and delivering a consistent quality of care. In order to achieve the best results with the lowest budget, gathering data about outcomes is paramount. Points out Schreckenberger, “If a procedure takes one hour and delivers better results than a similar procedure that takes two hours, it makes more sense all-round to elect for the former as far as it is medically possible.”

In Berlin, Heartbeat’s software has been on trial at Charité’s breast cancer centre since November. As Dr. Valerie Kirchberger explains, iPads with the Heartbeat app have been set up in the waiting room to follow the progress of patients with suspected breast cancer. Once patients arrive, they are invited to fill out a digital questionnaire around their health status and medical history, so when they go into the consulting room the data is available to their doctor immediately. For long-term follow-ups, patients are sent electronic surveys after the completion of treatment. Key data points are fed (anonymously) into an overview that can help Charité’s doctors better understand which techniques are likely to provide the best results.

But what about all the personal data that is being accrued – and the potential for its misuse? The consideration was understand- ably important to Charité, too. “We’re asking patients extremely personal and intimate questions, and obviously the last thing anyone would want is for that data to be breached or posted online. Data protection was the first question we asked,” says Kirchberger.

Schreckenberger explains that, for one, his team has no access to patient data: “At the start of every project, the first thing we do is sit down and look at data protection. In Charité’s case, the software and the resulting data are being hosted on the hospital’s own server. The software is always set up as such that only doctors have access – in the event of a hack, the system would get wiped and all data would be lost and worthless.”

He continues, “We’ve got a responsibility to make sure that the data is accurate and useful, and we’ve taken various steps to ensure this. For example, we’ve programmed the system so that doctors can’t manipulate the outcomes by removing unflattering or unsuccessful results.”

Back at Charité, the trial is thus far proving successful. “There were some concerns that maybe older patients would struggle with the iPad but this is far from the case. Most peo- ple like having something to do to pass the time in the waiting room, and for the doctors it’s rewarding for the results and outcome of their work to be visible,” says Kirchenberger. “Most people become doctors because they want to help people. But up until now once a patient is discharged, unless they come back or keep in touch, we’ve had little way of knowing how they’re getting on. The trial is helping us change this and deliver the best care for patients,” she says, heading into the clinic to do just that.